Cor pulmonale

It is defined as right heart failure due to long standing pulmonary hypertension. Which leads to enlargement of the right ventricles and eventually right heart failure ensues.

This disease also known as Pulmonary haert disease.
This disease solely caused by primary disorders of respiratory system
If this disease is chronic then right ventricular hypertrophy develops progressively but in case of acute cor pulmonale right ventricular dilatation may occur due to acute increase pressure instead of hypertrophy.
Right sided ventricular disease caused by a primarily left sided heart disease or congenital heart disease is not considered as cor pulmonale.
Almost any chronic lung disease or condition causing prolonged low oxygen blood flow can lead to cor pulmonale

Causes of cor pulmonale:

Chronic obstructive pulmonary disease ( COPD )***
Primary pulmonary hypertension***
Cystic fibrosis
Interstitial lung disease ( Due to scarring of lung tissue )
Obstructive sleep apnea
Recurrent pulmonary embolism ( Chronic blood clots in the lungs)
Sarcoidosis
Kyphoscoliosis
Pneumoconiosis
Altitude sickness
Sickle cell anemia
Loss of lung tissue following lung trauma or surgery

Acute causes

Acute massive pulmonary embolism***
Acute respiratory distress sysndrome ( ARDS )
Acute exacerbation of cor pulmonale

Mnemonics for causes of Cor pulmonale: PuLmonary HTN
P = Pulmonary vascular disease

Primary pulmonary hypertension
Pulmonary embolism ( Acute massive PE or Chronic recurrent PE )
Pulmonary vasculitis
Sickle cell anemia
ARDS
Parasite infestation

L = Lung disease

COPD
Asthma ( Severe, Chronic)
Bronchiectasis
Cystic fibrosis
Interstitial lung disease
Loss of lung tissue following lung trauma or surgery
Sarcoidosis
Pneumoconiosis

H = Hypoventilation

Obstructive sleep apnea
Cerebrovascular disease
Adenoids enlargements in children

T= Thoracic abnormality

Kyphosis
Scoliosis

N = Neuromuscular disease

Polioymyelitis
Motor neurone disease
Myasthenia gravis

Pathophysiology

1, Pumonary vasoconstriction

Due to respiratory disease and poor lung function can leads to alveolar hypoxia and blood acidemia.
Alveolar hypoxia and blood acidemia can results in vasoconstriction of pulmonary arteries
This mechanism leads to pulmonary hypertension and if not treated cor pulmonale ensues

2, Anatomic changes in pulmonary vascular bed

It occurs secondary to parenchymal lung disease or alveolar lung diseases. e.g Emphysema in COPD, interstitial lung disease, massive pulmonary emobolism, cystic fibrosis.
This causes increased in pulmonary pressure

3, Hyperviscosity of blood

Increased blood viscosity is secondary to polycythemia vera ( secondary), sickle cell anemia, macroglobulinemia

4, Increased blood flow in pulmonary vasculature

5, Idiopathic or primary pulmonary hypertension

All above mechanism finally leads to increased pulmonary hypertension and later develop cor pulmonale

Clinical presentation

Symtpoms:

Shortness of breath ( Initially exertional dyspnea but in severe cases can occurs at rest )
Wheezing
Fatigue and syncopal attack
Chest discomfort with anginal pain due to RV ischemia or pulmonary artery stretching
Chronic wet cough
Hemoptysis
Ascites
Hepatomegaly and hepatic congestion secondary to right heart failure
Anorexia due to hepatic involvement
Right upper quadrant abdominal pain and discomfort due to hepatomegaly and congestion
Abnormal heart sounds
Hoarseness of voice due to compression of left recurrent laryngeal nerve by dilated pulmonary artery ( very rare )

Inspection: